Each year, an estimated 32,000 Americans commit suicide, about 1,500 of which occur within hospital facilities in the United States. About one-third of suicides occurring in hospitals take place even though patients are being checked on every 15 minutes. “The ED has the second highest number of reported completed suicides and attempts, trailing only inpatient psychiatric units,” says Peter D. Mills, PhD, MS. “Many important risk factors—including suicidal ideation or a history of suicide attempts—are not documented as part of initial ED assessments, yet more than 300,000 people are treated in EDs for self-harm each year. Understanding more about methods of suicides and attempts and the factors contributing to these events is an important initial step in eliminating these preventable adverse events.” Characterizing Suicides in the ED Previous studies have explored specific patient characteristics for those who have committed suicide while in the hospital, while others have looked at environmental factors relating to inpatient suicides and attempts. Few studies, however, describe suicide attempts in the ED and identify environmental hazards that increase suicide risk in this setting. In a 10-year study, Dr. Mills and colleagues conducted a retrospective review of all root-cause analysis reports of suicide attempts or completions in the VA healthcare system. Published in the May 2012 Emergency Medicine Journal, the study categorized the method of suicides as well as the root causes of suicides and attempts in the ED. According to findings, about 10% of suicides and suicide attempts that occurred within the hospital happened in the ED. Hanging, cutting, and strangulation were the most common methods used for suicides and attempts (Figure 1). Doors were...